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Restricting Insulin Dose Increases Risk of Death


About a third of women with type 1 diabetes have limited their insulin injections at some point in their lives in order to lose weight, researchers have found. They also discovered that these women are more likely to die younger from complications of the disease. Rose Hoban has details.

Diabetes is a disease that occurs when the body can no longer take sugar from the blood stream and efficiently use it as energy. Older adults frequently develop type 2 diabetes, especially if they're overweight.

But type 1 diabetes is a disorder of children. It's one of the most common chronic diseases of childhood. Children with the disease almost always need insulin shots to survive.

Many adolescents and young adults with diabetes find themselves frustrated by the strict limits on their behavior the disease requires. They have to be extremely careful about when and what they eat, and they have to have frequent shots.

Ann Goebel-Fabbri is an instructor at Harvard Medical School, who practices at the Joslin Diabetes Center in Boston. She says eating disorders can become an issue in many adolescents and young adults. "I treat a lot of women here," she notes, "who struggle with diabetes and eating disorders."

When Goebel-Fabbri came to work at Joslin, researchers there had already collected initial data on a cohort of women who had been evaluated. They were all women with type 1 diabetes who had been evaluated on eating disorder symptoms and other emotional phenomena like depression and anxiety, as well as distress related to coping with diabetes on a day-to-day basis.

Goebel-Fabbri says about 30 percent of these women admitted to limiting their insulin intake at some point in their lives. The women frequently did this in order to lose weight. But she says that's playing with fire.

"[It's] similar to the types of dangerous behaviors that women without diabetes might engage in, like crash dieting, or use of laxatives or diet pills, things of that nature," she says. "We know [those behaviors] are not healthy, but outside of the context of such a medically complicated disease like diabetes, they may convey less of a risk."

Goebel-Fabbri and her colleagues at the Center followed these women for a decade. They found that, on average, the women who limited their insulin intake died younger from diabetes and its complications than women who took their insulin regularly. Goebel-Fabbri says dying young from diabetes is a waste. "Treatment for type 1 diabetes is outstanding, right now."

"The tools and strategies that we have to help manage blood glucose close and prevent the complications of this disease are already here. And so, preventing complications and improving quality of life is possible."

Goebel-Fabbri says it's important that doctors assess their diabetic patients for eating disorders and their use of insulin to help prevent this from happening.

Her research is published in the journal Diabetes Care.

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